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Aetna Medicare Value Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Aetna Medicare Value Plus (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Aetna Medicare Value Plus (HMO) in 2026, please refer to our full plan details page.
Aetna Medicare Value Plus (HMO) is a HMO plan offered by CVS Health Corporation available for enrollment in 2025 to people living in Wichita Kansas Area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that Aetna Medicare Value Plus (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Aetna Medicare Value Plus (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Aetna Medicare Value Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $44.10. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Aetna Medicare Value Plus (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when using a preferred pharmacy or preferred mail-order service for any supply duration. If you choose a standard pharmacy or standard mail-order service, copays range from $2.00 to $6.00 for Tier 1 drugs and $12.00 to $36.00 for Tier 2 drugs depending on the supply duration. For higher-tier medications, costs transition to a coinsurance model across all pharmacy and mail-order options. Tier 3 preferred brand drugs require a 22% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs require a 25% coinsurance. Note that Tier 5 specialty drugs are limited to a 1-month supply at this 25% coinsurance rate.
Additional Benefits
The Aetna Medicare Value Plus (HMO) plan features comprehensive medical coverage with no copay and no coinsurance for primary care physician visits and home health services. Specialist visits and urgent care services require a low copay of up to $25, while emergency room visits carry a $130 copay that is waived if you are admitted. Inpatient hospital stays require a daily copay of $250 for the first six days of acute care, after which there is no copay for the remainder of a standard Medicare-covered stay. For extra benefits, the plan offers no copay and no coinsurance for preventive dental, routine annual vision exams, and routine hearing exams, including a $400 annual eyewear allowance and a $1,250 annual hearing aid allowance per ear. Diagnostic lab services and X-rays also feature no copay, while durable medical equipment and dialysis require no copay but carry coinsurance up to 20%. Members can also take advantage of over-the-counter benefits with no copay up to a $75 limit every three months.
Inpatient Hospital See details
Aetna Medicare Value Plus (HMO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $250 for days 1 to 6 of acute care and $270 for days 1 to 6 of psychiatric care, followed by no copay for days 7 to 90. While unlimited additional acute care days are covered at no cost, prior authorization is required, and non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by Aetna Medicare Value Plus (HMO) with no coinsurance across all categories, including no copay for ambulatory surgical center and blood services. Medicare-covered outpatient hospital services have a copay of $0 to $300 ($250 per stay for observation), and outpatient substance abuse sessions require a $25 copay.
Partial Hospitalization See details
Aetna Medicare Value Plus (HMO) covers partial hospitalization services with a copay of either $85.00 or $145.00 and no coinsurance. Prior authorization is required for these covered benefits.
Ambulance and Transportation Services See details
Aetna Medicare Value Plus (HMO) covers ground ambulance services with a $260 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. While some transportation services are covered under this plan, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Aetna Medicare Value Plus (HMO) covers emergency services with a $130 copay (waived if admitted to the hospital within 24 hours) and no coinsurance, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency coverage is also provided with no coinsurance up to a $250,000 limit, with copays of $130 for emergency or urgent care and $260 for emergency transportation.
Primary Care See details
Primary care benefits under Aetna Medicare Value Plus (HMO) feature no copay and no coinsurance for primary care physician visits, while specialist, physical therapy, and mental health services require a $0 to $25 copay with no coinsurance. Telehealth services are covered with a $0 to $25 copay and 20% coinsurance, but chiropractic services are not covered.
Preventive Services See details
Preventive Services under the Aetna Medicare Value Plus (HMO) are partially covered, offering no copay and no coinsurance for most services like annual physicals, fitness benefits, and health screenings. However, kidney disease education has no copay but requires a 20% coinsurance, and several services, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs, are not covered.
Hearing Services See details
Hearing services are covered by Aetna Medicare Value Plus (HMO), offering Medicare-covered exams for a $25 copay and no coinsurance, alongside annual routine exams and fittings with no copay and no coinsurance. Prescription hearing aids are covered up to $1,250 per ear annually with no copay or coinsurance, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
Vision services are covered by Aetna Medicare Value Plus (HMO) with no copay, no coinsurance, and no deductible for both exams and eyewear. This benefit includes one annual routine eye exam, follow-up diabetic eye exams, and a $400 yearly maximum allowance for contacts, eyeglasses, frames, lenses, and upgrades.
Dental Services See details
Dental services are partially covered by Aetna Medicare Value Plus (HMO), featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for preventive exams, cleanings, and x-rays. Covered comprehensive services require no copay with 20% to 50% coinsurance up to a $3,500 annual limit, though fluoride, implants, orthodontics, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Aetna Medicare Value Plus (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
The Aetna Medicare Value Plus (HMO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Aetna Medicare Value Plus (HMO) covers medical equipment, including durable medical equipment (DME), prosthetics, and diabetic supplies, with no copay and prior authorization required. While there is no copay, coinsurance ranges from no coinsurance up to 20% depending on the specific equipment or supplies.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under Aetna Medicare Value Plus (HMO) with prior authorization required. Diagnostic tests and procedures have a $0 to $25 copay and no coinsurance, lab services and X-rays have no copay or coinsurance, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
Aetna Medicare Value Plus (HMO) covers home health services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Aetna Medicare Value Plus (HMO) covers some services for Cardiac Rehabilitation Services with no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and require a $5 copay.
Skilled Nursing Facility (SNF) See details
Aetna Medicare Value Plus (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Aetna Medicare Value Plus (HMO) covers acupuncture with a $20 copay and no coinsurance for up to 12 treatments per year, alongside over-the-counter items with no copay and no coinsurance up to a $75 limit every three months. Chronic illness meal benefits, annual wellness exams, screening mammographies, and select additional colorectal cancer screenings are also covered with no copay and no coinsurance.
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